Discussions About Public Figures: Clinician, Commentator, or Educator?

Psychiatrists and other mental health professionals are frequently called on by the media to give their expert opinion about public figures whose behavior raises a question about their mental health or fitness. Often, this involves colorful, eccentric, or flagrant misbehavior in the sexual or financial realm.

Consider, for example, former Congressman Anthony Weiner who resigned his seat June 16, 2011, amid revelations of his repeated lewd online behavior: Mr Weiner admitted to having texted pictures of his penis to at least one woman.1 In the summer of 2013, while running as a mayoral candidate in the Democratic primary in New York City, it was revealed that he had continued to post lewd images of himself online, and he was pressured (unsuccessfully) to quit the race.2

Understandably, the media sought commentary from mental health experts. How, they asked, was the public to understand such apparently self-destructive behavior?

Some mental health professionals suggested Mr Weiner’s indiscretions might be an addiction. Others theorized that he might be driven by sexual needs that were unmet in his marriage and by feelings of inadequacy about his masculinity. Still others raised the possibility of a mood disorder.3

As psychiatrists, we have expert knowledge about human behavior and mental illness. Thus, we have a potentially unique—and powerful—influence in the discussion of public figures. But what professional and ethical obligations should we follow in this role? Are we to relate to the public as expert clinicians, commentators, or educators—or some mix of these roles?

Background

To answer the question, a bit of historical perspective is instructive. Just before the 1964 presidential election, a muckraking and now defunct magazine called Fact decided to survey members of the American Psychiatric Association (APA) for their professional assessment of Senator Barry Goldwater of Arizona, the Republican nominee running against President Lyndon B. Johnson.4 Ralph Ginzburg, the magazine’s notoriously provocative publisher, had heavily advertised the issue in advance, saying it would call into question Mr Goldwater’s character.

APA members were asked whether they thought Mr Goldwater was fit to be president and what their psychiatric impressions of him were. It was not American psychiatry’s finest hour. The survey, highly unscientific even by the standards of the time, was sent to 12,356 psychiatrists, of whom 2417 responded. The results were published as a special issue: “The Unconscious of a Conservative: A Special Issue on the Mind of Barry Goldwater.”

The psychiatrists’ assessment was very harsh. Half of the respondents judged Mr Goldwater psychologically unfit to be president. They used terms like “megalomaniac,” “paranoid,” and “grossly psychotic.” Some offered specific diagnoses, including schizophrenia and narcissistic personality disorder. Only 27% of the respondents said Mr Goldwater was mentally fit, and 23% said they did not know enough about him to make a judgment.

Disclosures:

Dr Friedman is Professor of Clinical Psychiatry and Director of the Psychopharmacology Clinic at Weill Cornell Medical College in NY. He reports no conflicts of interest concerning the subject matter of this article.